Hysterectomy: Surgery to remove your uterus
Understand when a hysterectomy is necessary. Find out how hysterectomy is done, what you can expect during recovery and what alternatives to hysterectomy exist.
Hysterectomy — the surgical removal of your uterus — can mean survival if you have uterine cancer. Or if you're a woman with intolerable pelvic pain from endometriosis or heavy, irregular periods, a hysterectomy often means relief from troublesome symptoms.
Hysterectomy ranks as one of the most common surgical procedures among women. But when is a hysterectomy really necessary? Discover why you might need a hysterectomy, what's involved in the procedure and what your alternatives might be.
What is a hysterectomy recommended for?
Hysterectomy may be needed if you have one of the following conditions:
Hysterectomy ends your ability to become pregnant. If you think you might want to become pregnant, ask your doctor about alternatives to this surgery. In the case of cancer, hysterectomy might be the only option. But other conditions — including fibroids, endometriosis and uterine prolapse — have alternative treatments that you can try first.
How do you prepare for a hysterectomy?
Hysterectomy is an inpatient procedure — meaning you're admitted to the hospital to have it done. How long you'll be in the hospital depends on what type of hysterectomy you have and what your doctor recommends.
Plan for an extended recovery time once you get home. Full recovery could take several weeks. Before your surgery, arrange for time off work. Look into getting help at home if you think you'll need it.
How is a hysterectomy done?
To perform a hysterectomy, a surgeon detaches your uterus from the blood vessels and connective tissue that support it, as well as from the vagina. Depending on your situation, surgery may involve the removal of additional organs and tissue.
Types of hysterectomy surgery include:
A hysterectomy typically is performed under general anesthesia, so you won't be awake during the surgery. The procedure itself lasts about one to two hours, although you'll spend some time beforehand getting ready to go into the operating room.
Routes by which a hysterectomy can be performed
A hysterectomy can be performed through an incision in your abdomen (abdominal hysterectomy) or through your vagina (vaginal hysterectomy). Which procedure is best for you depends on your specific situation.
In abdominal hysterectomy, the surgeon cuts through skin and connective tissue in your lower abdomen to reach your uterus. The surgeon uses one of two types of abdominal incisions for the hysterectomy. A vertical incision starts in the middle of your abdomen and extends from just below your navel to just above your pubic bone. A horizontal bikini-line incision (Pfannenstiel incision) lies about an inch above your pubic bone.
The advantage of an abdominal procedure is that your surgeon can see your uterus and other organs and has more room to operate than if the procedure is done vaginally. For this reason, your surgeon may opt for the abdominal procedure if you have large tumors or if your doctor suspects the presence of cancer.
On the other hand, abdominal hysterectomy can mean:
In a vaginal hysterectomy, the surgeon reaches your uterus by making a circular incision around the cervix. This approach is best for benign conditions that lead to hysterectomy when the uterus isn't too large. It's often the best approach for uterine prolapse. With a vaginal hysterectomy, you won't have any external scarring. You may also recover more quickly because you aren't waiting for a large abdominal incision to heal and the nerve signals from the top of the vagina aren't perceived in the same manner as those from the skin.
However, vaginal hysterectomy gives the surgeon less room to operate and no real opportunity to view your pelvic organs.
Laparoscopic hysterectomies have now been made much safer with the advent of the Harmonic Scalpel. Till the Harmonic Scalpel came about [and still in most centers in India], the instrument used for hysterectomies is the "Bipolar Electrosurgical Unit". The Harmonic is much safer, faster and has many advantages over the older "electro surgery". More information here.
Laparoscopically-assisted vaginal hysterectomy [LAVH] allows your doctor to view your pelvis and to remove your uterus vaginally when it otherwise would require a large abdominal incision. The surgeon makes a small incision near your navel to insert a thin device (laparoscope) that allows the surgical team to see inside your abdomen. Through other tiny incisions, your surgeon uses special surgical instruments to detach the uterus and then remove it through your vagina.
Total laparoscopic hysterectomy [TLH] is a procedure where the entire hysterectomy is done laparoscopically and the uterus may either be removed via the vagina or morcellated [cut up into small pieces], and removed thru the keyholes in your abdomen.
TLH, or total laparoscopic hysterectomy is now considered the gold standard or standard of care as far as hysterectomies are concerned.
Laparoscopic Supracervical Hysterectomy [LSH] is a procedure by which the body of the uterus is removed laparoscopically while the cervix is left behind. This may now be making a comeback as the risks are much less with this type of surgery and it can be performed much faster and therefore anaesthesia risk is reduced too.
LSH causes less stress to the body than the traditional "open" hysterectomy. It was developed to reduce pain, minimize scarring, and shorten recovery time. The procedure can be done on an outpatient basis, which means a woman can be home resting comfortably within 24 hours and back to her normal activities in less than a week. As with all surgery, hysterectomy involves risk, including potential blood loss, infection and damage to other internal organs.
LSH preserves the cervix, which some research suggests may help to reduce the risk of pelvic floor prolapse, urinary incontinence and other complications associated with total hysterectomies. Because the cervix is left in place, however, you must be willing to continue annual pap smears to screen for cervical cancer.
After the hysterectomy
After surgery, you'll remain in the recovery room for a few hours. You'll be monitored for signs of pain and discomfort. You'll take medicine for pain and to prevent infection. You'll probably be up and walking around by the following day. You'll need to use sanitary pads for vaginal bleeding and discharge. It's normal to have bloody drainage for several days after a hysterectomy.
Understand that you won't be back to your usual self for at least four to six weeks. If you've had a vaginal hysterectomy, you might feel better long before this time, but it's important to adhere to activity restrictions. If you have undergone a minimally invasive procedure like a LSH or a TLH you should be discharged on the day after surgery and should be back to normal within a week or so. Get plenty of rest. Don't lift anything heavy for a full six weeks after the operation. Your doctor may recommend other restrictions, but eventually you'll return to your normal activities.
If you're premenopausal, having your ovaries removed initiates menopause. Discuss with your doctor ways to handle menopausal symptoms, such as hot flashes and vaginal dryness. If you're younger than age 45 and you had your ovaries removed, you're at increased risk of osteoporosis. Ask your doctor about an osteoporosis prevention program.
About six weeks after your surgery, you can resume sexual activity. Having a hysterectomy shouldn't affect this aspect of your life. This issue has been carefully studied, and women with a good sex life before hysterectomy maintain it afterward. Some women even experience an increase in sexual pleasure. This may be associated with relief from the chronic pain or heavy bleeding that was caused by a uterine problem.
Risks of hysterectomy
Hysterectomy is generally very safe, but with any major surgery comes the risk of complications. Such complications include blood clots, infection, excessive bleeding or an adverse reaction to the anesthesia.
Other risks of hysterectomy are:
Talk with your doctor about the risks of surgery as they apply to you.
Because the uterus is strongly associated with femininity, you may feel a sense of loss after a hysterectomy. On the other hand, you may find hysterectomy provides relief of symptoms, an enhanced sense of well-being and a chance to get on with your life. The relief of symptoms may greatly enhance your quality of life.
Think about your reasons for hysterectomy and what it means to end your ability to become pregnant. Before proceeding with this surgery, make sure it's right for you. Don't hesitate to get a second opinion if you're not certain that hysterectomy is your best option.
Understanding your treatment
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